The impact of COVID-19 on routine pediatric vaccination delivery in Brazil

Carolina Moura; Paul Truche; Lucas Sousa Salgado; Thiaro Meireles; Vitor Santana; Alexandra Buda; Aline Bentes; Fabio Botelho; David Mooney

doi:10.1016/j.vaccine.2022.02.076

The impact of COVID-19 on routine pediatric vaccination delivery in Brazil

Vaccine. 2022 Apr 1;40(15):2292-2298. doi: 10.1016/j.vaccine.2022.02.076. Epub 2022 Mar 1.

Authors

Carolina Moura¹, Paul Truche², Lucas Sousa Salgado³, Thiaro Meireles⁴, Vitor Santana⁵, Alexandra Buda², Aline Bentes⁶, Fabio Botelho⁷, David Mooney⁸

Affiliations

¹ Faculdade da Saúde e Ecologia Humana, FASEH, Vespasiano, MG, Brazil.
² Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
³ União Educacional do Vale do Aço, UNIVAÇO, Departamento de Medicina, Ipatinga, MG, Brazil.
⁴ Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, SP, Brazil.
⁵ Faculdade de Medicina da Universidade Federal de Minas Gerais, UFMG, Belo Horizonte, MG, Brazil.
⁶ Faculdade de Medicina da Universidade Federal de Minas Gerais, Departamento de Infectologia Pediátrica, Belo Horizonte, MG, Brazil.
⁷ Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
⁸ Boston Children's Hospital, Boston, MA, USA. Electronic address: david.mooney@childrens.harvard.edu.

Abstract

Introduction: Childhood vaccination rates have decreased significantly during the COVID-19 pandemic. The Brazilian immunization program, Programa Nacional de Imunização (PNI), is a model effort, achieving immunization rates comparable to high-income countries. This study aimed to evaluate the impact of the COVID-19 pandemic in pediatric vaccinations administered by the PNI, as a proxy of adherence to vaccinations during 2020.

Methods: Data on the number of vaccines administered to children under 10 years of age nationally and in each of Brazil's five regions were extracted from Brazil's federal health delivery database. Population adjusted monthly vaccination rates from 2015 through 2019 were determined, and autoregressive integrated moving average (ARIMA) models were used to forecast expected vaccinated rates in 2020. We compared the forecasts to reported vaccine administrations to assess adequacy of pediatric vaccine delivery during the COVID-19 pandemic.

Results: From January 2015 to February 2020, the average rate of vaccine administration to children was 53.4 per 100,000. After February 2020, this rate decreased to 50.4, a 9.4% drop compared to 2019 and fell outside of forecasted ranges in December 2020. In Brazil's poorest region, the North, vaccine delivery fell outside of the forecasted ranges earlier in 2020 but subsequently rebounded, meeting expected targets by the end of 2020. However, in Brazil's wealthiest South and Southeast regions, initial vaccine delivery fell and remained well below forecasted rates through the end of 2020.

Conclusion: In Brazil, despite a model national pediatric vaccination program with an over 95% national coverage, vaccination rates decreased during the COVID-19 pandemic. Coordinated governmental efforts have ameliorated some of the decrease, but more efforts are needed to ensure continued protection from preventable communicable diseases for children globally.

Keywords: Child Health; Health inequity; Health policy; Vaccination.

MeSH terms

Brazil / epidemiology
COVID-19* / epidemiology
COVID-19* / prevention & control
Child
Humans
Immunization Programs
Pandemics / prevention & control
Vaccination